Adams JA. Sexual Abuse in Children: What the General Practice Ob/Gyn Needs to Know. Clinical Obstetrics and Gynecology. 2020; 63 (3) : 486-490.
Keywords: Adolescent, Child, *Child Abuse, Sexual/prevention & control/psychology/statistics & numerical data, Female, Genitalia, Female/*anatomy & histology/physiology, Gynecological Examination/*methods, Gynecology/*methods, Humans, Physical Examination/*methods,
The medical evaluation of a child who may have been sexually abused can be a …
The medical evaluation of a child who may have been sexually abused can be a challenge for physicians who are unfamiliar with the wide variation in normal genital anatomy in prepubertal girls. Signs of injury are rarely found, unless the child is examined within 72 hours of the event. This article will provide some history about how guidelines for medical care of these children have been developed, and list some of the findings that are normal or normal variants, caused by other conditions, or due to trauma or infection.
Adams JA, Kellogg ND, Farst KJ, Harper NS, Palusci VJ, Frasier LD, Levitt CJ, Shapiro RA, Moles RL, Starling SP. Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. Journal of Pediatric and Adolescent Gynecology. 2016; 29 (2) : 81-87.
Keywords: Child sexual abuse,Differential diagnosis,Expert opinion,Expert testimony,Medical history taking,Peer review,Sexually transmitted infections
The medical evaluation is an important part of the clinical and legal process …
The medical evaluation is an important part of the clinical and legal process when child sexual abuse is suspected. Practitioners who examine children need to be up to date on current recommendations regarding when, how, and by whom these evaluations should be conducted, as well as how the medical findings should be interpreted. A previously published article on guidelines for medical care for sexually abused children has been widely used by physicians, nurses, and nurse practitioners to inform practice guidelines in this field. Since 2007, when the article was published, new research has suggested changes in some of the guidelines and in the table that lists medical and laboratory findings in children evaluated for suspected sexual abuse and suggests how these findings should be interpreted with respect to sexual abuse. A group of specialists in child abuse pediatrics met in person and via online communication from 2011 through 2014 to review published research as well as recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics and to reach consensus on if and how the guidelines and approach to interpretation table should be updated. The revisions are based, when possible, on data from well-designed, unbiased studies published in high-ranking, peer-reviewed, scientific journals that were reviewed and vetted by the authors. When such studies were not available, recommendations were based on expert consensus.
Adams JA, Farst KJ, Kellogg ND. Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018. Journal of Pediatric and Adolescent Gynecology. 2018; 31 (3) : 225-231.
Keywords: Chlld sexual abuse,Medical findings,Sexually transmitted diseases
Most sexually abused children will not have signs of genital or anal injury, …
Most sexually abused children will not have signs of genital or anal injury, especially when examined nonacutely. A recent study reported that only 2.2% (26 of 1160) of sexually abused girls examined nonacutely had diagnostic physical findings, whereas among those examined acutely, the prevalence of injuries was 21.4% (73 of 340). It is important for health care professionals who examine children who might have been sexually abused to be able to recognize and interpret any physical signs or laboratory results that might be found. In this review we summarize new data and recommendations concerning documentation of medical examinations, testing for sexually transmitted infections, interpretation of lesions caused by human papillomavirus and herpes simplex virus in children, and interpretation of physical examination findings. Updates to a table listing an approach to the interpretation of medical findings is presented, and reasons for changes are discussed.
Adams JA, Starling SP, Frasier LD, Palusci VJ, Shapiro RA, Finkel MA, Botash AS. Diagnostic accuracy in child sexual abuse medical evaluation: role of experience, training, and expert case review.. Child Abuse & Neglect. 2012; 36 (5) : 383-92.
Keywords: Anal Canal, Child, Child Abuse, Sexual/*diagnosis, Clinical Competence/*standards, Diagnosis, Differential, Genitalia, Health Knowledge, Attitudes, Practice, Humans, Pediatric Nursing/*standards, Pediatrics/*standards, Photography, Physical Examination/*s
OBJECTIVES: (1) The purpose of this study was to assess the ability of …
OBJECTIVES: (1) The purpose of this study was to assess the ability of clinicians who examine children for suspected sexual abuse to recognize and interpret normal and abnormal ano-genital findings in magnified photographs using an online survey format. (2) Determine which factors in education, clinical practice, and case review correlate with correct responses to the survey questions. METHODS: Between July and December 2007, medical professionals participated in a web-based survey. Participants answered questions regarding their professional background, education, clinical experience, and participation in case review. After viewing photographs and clinical information from 20 cases, participants answered 41 questions regarding diagnosis and medical knowledge. Answers chosen by an expert panel were used as the correct answers for the survey. RESULTS: The mean number of correct answers among the 141 first-time survey respondents was 31.6 (SD 5.9, range 15-41). Child Abuse Pediatricians (CAP) had mean total scores which were significantly higher than Pediatricians (Ped) (34.8 vs. 30.1, p<0.05) and Sexual Assault Nurse Examiners (SANE) (34.8 vs. 29.3, p<0.05). The mean total scores for Ped, SANE, and Advanced Practice Nurses (APN) who examine fewer than 5 children monthly for possible CSA were all below 30. Total score was directly correlated with the number of examinations performed monthly (p=0.003). In multivariable regression analysis, higher total score was associated with self-identification as a CAP, reading The Quarterly Update newsletter (p<0.0001), and with quarterly or more frequent expert case reviews using photo-documentation (p=0.0008). CONCLUSIONS: Child Abuse Pediatricians, examiners who perform many CSA examinations on a regular basis, examiners who regularly review cases with an expert, and examiners who keep up to date with current research have higher total scores in this survey, suggesting greater knowledge and competence in interpreting medical and laboratory findings in children with CSA. Review of cases with an expert in CSA medical evaluation and staying up to date with the CSA literature are encouraged for non-specialist clinicians who examine fewer than 5 children monthly for suspected sexual abuse.
Ali-Panzarella AZ. A Diagnostic Approach to Conditions that Mimic Sexual Abuse.. Pediatric Annals. 2020; 49 (8) : e334-e340.
Keywords: Anal Canal/injuries, Anus Diseases/*diagnosis/therapy, Child, Child Abuse, Sexual/*diagnosis, Child, Preschool, Diagnosis, Differential, Female, Genital Diseases, Female/*diagnosis/therapy, Genital Diseases, Male/*diagnosis/therapy, Genitalia/injuries, Hu
Primary care providers are often the first point of contact when there are …
Primary care providers are often the first point of contact when there are concerns of child sexual abuse. The history is the key factor in making the diagnosis as most children who have experienced child sexual abuse do not have an abnormal anogenital examination. When anogenital symptoms precipitate concerns for sexual abuse, especially in the absence of a history of sexual abuse, it is important to be aware of conditions that mimic sexual abuse. Being familiar with such conditions allows the provider to determine appropriate management, differentiate an anatomical variant or medical condition from abuse, and provide reassurance to the patient and family. Unnecessarily reporting these cases can have detrimental effects on the patient and family. If any doubt arises, patients can be referred for further evaluation by an expert in child abuse. This article presents many common medical conditions that can mimic sexual abuse, with a focus on history, examination findings, and management. [Pediatr Ann. 2020;49(8):e334-e340.].
Collins JA, Maney JA, Livingstone A. Fifteen-minute consultation: Apparent vaginal bleeding in the pre-pubertal girl. Archives of Disease in Childhood. Education and Practice Edition. 2021; 106 (3) : 142-148.
Keywords: Child, Child Abuse, Sexual, Emergency Service, Hospital, Female, Humans, Puberty, Referral and Consultation, *Uterine Hemorrhage/diagnosis/etiology
A parent or carer's observation of blood in a child's nappy or underwear can be …
A parent or carer's observation of blood in a child's nappy or underwear can be quite alarming for both parent and child and may indicate vaginal bleeding. At first glance, it may be difficult to ascertain whether the bleeding is from the skin, genital tract, urinary tract or anus. Confirmed vaginal bleeding in a pre-pubertal girl is rare but always abnormal and requires comprehensive assessment to determine the cause. Recognition of normal female pre-pubertal anatomy is essential to detect any abnormalities. Appropriate action should be taken according to findings on initial inspection of the ano-genital area. The possibility of child sexual abuse and the need for specialist paediatric sexual offences medicine examination by an FME (Forensic Medical Examiner) or specialist paediatrician should always be considered. This article offers a systematic approach to assessment in pre-pubertal girls with apparent vaginal bleeding which will benefit general paediatricians, emergency department practitioners and GPs.
Dwiggins M, Gomez-Lobo V. Current review of prepubertal vaginal bleeding.. Current Opinion in Obstetrics & Gynecology. 2017; 29 (5) : 322-327.
Keywords: Child, Child Abuse, Sexual/diagnosis, Child, Preschool, Female, Genital Neoplasms, Female/*complications, Humans, Infant, Infant, Newborn, Medical History Taking, Physical Examination, Puberty, Puberty, Precocious/complications, Skin Diseases/complication
PURPOSE OF REVIEW: Prepubertal vaginal bleeding raises many concerns and …
PURPOSE OF REVIEW: Prepubertal vaginal bleeding raises many concerns and evaluation and diagnosis may prove difficult for many providers. We aim to provide a comprehensive review and recent updates for those practitioners who care for these patients. RECENT FINDINGS: Prompt management in the case of prepubertal vaginal bleeding is indicated, especially to rule out malignancy or abuse. If a child is reluctant to undergo examination, or if the extent of injury or source of bleeding cannot be determined, examination under anesthesia and vaginoscopy is recommended. Use of vaginoscopy allows for clear visualization of the vagina and cervix without distorting hymenal anatomy, as well as diagnosis and removal of a foreign body and evaluation of mucosal damage caused. In the case of sexual abuse, providers specifically trained in pediatrics need to be present, and safety of the patient should always be ensured. SUMMARY: Careful history taking and targeted examination may lead to diagnosis in the case of prepubertal vaginal bleeding. However, in more difficult cases, practitioners should not hesitate to examine a patient in the operating room using general anesthesia to elicit the cause. Although sexual abuse and malignancy are always on the differential, most causes of bleeding are benign and easily treated.
Gallion HR, Milam LJ, Littrell LL. Genital Findings in Cases of Child Sexual Abuse: Genital vs Vaginal Penetration. Journal of Pediatric and Adolescent Gynecology. 2016; 29 (6) : 604-611.
Keywords: Adolescent sexual assault,Child sexual abuse,Genital injury,Penetration
Study Objective To (1) examine the prevalence of abnormal genital findings in a …
Study Objective To (1) examine the prevalence of abnormal genital findings in a large cohort of female children presenting with concerns of sexual abuse; and (2) explore how children use language when describing genital contact and genital anatomy. Design In this prospective study we documented medical histories and genital findings in all children who met inclusion criteria. Findings were categorized as normal, indeterminate, and diagnostic of trauma. Logistic regression analysis was used to determine the effects of key covariates on predicting diagnostic findings. Children older than 4 years of age were asked questions related to genital anatomy to assess their use of language. Setting A regional, university-affiliated sexual abuse clinic. Participants Female children (N = 1500) aged from birth to 17 years (inclusive) who received an anogenital examination with digital images. Interventions and Main Outcome Measures Physical exam findings, medical history, and the child's use of language were recorded. Results Physical findings were determined in 99% (n = 1491) of patients. Diagnostic findings were present in 7% (99 of 1491). After adjusting for age, acuity, and type of sexual contact reported by the adult, the estimated odds of diagnostic findings were 12.5 times higher for children reporting genital penetration compared with those who reported only contact (95% confidence interval, 3.46-45.34). Finally, children used the word “inside” to describe contact other than penetration of the vaginal canal (ie, labial penetration). Conclusion A history of penetration by the child was the primary predictor of diagnostic findings. Interpretation of children's use of “inside” might explain the low prevalence of diagnostic findings and warrants further study.
Hadley J, Moore J, Goldberg A. Sexual Abuse as a Cause of Prepubertal Genital Bleeding: Understanding the Role of Routine Physical Examination.. Journal of Pediatric and Adolescent Gynecology. 2021; 34 (3) : 288-290.
Keywords: Child, Child Abuse, Sexual/*diagnosis/psychology, Child, Preschool, Diagnosis, Differential, Disclosure, Female, Genitalia, Female/*injuries, Hemorrhage/diagnosis/*etiology, Humans, Pediatrics, Physical Examination
Although accidental trauma is the most common mechanism for genital bleeding, …
Although accidental trauma is the most common mechanism for genital bleeding, sexual abuse should be considered when the patient is prepubertal and/or a vague history of bleeding is provided. Prepubertal female genital exams should be completed routinely; this clinical technique is critical for pediatricians to assess pubertal progression, to identify pathologies or differences in sexual differentiation, and to narrow a broad differential diagnosis of bleeding. Physical evidence of sexual abuse on exam is rarely found, and therefore the diagnosis relies on a child's disclosure. Physicians should be cognizant of barriers to patient disclosure. In this commentary we aim to provide general pediatricians and trainees with a framework for evaluating genital/vaginal bleeding in prepubertal girls, by discussing the following: (1) the importance of a complete anogenital exam in generating a differential diagnosis; and (2) the possibility of sexual abuse as an etiology with recognition that the disclosure process is complex.
Jenny C, Crawford-Jakubiak JE. The evaluation of children in the primary care setting when sexual abuse is suspected.. Pediatrics. 2013; 132 (2) : e558-67.
Keywords: Adolescent, Child, Child Abuse, Sexual/*diagnosis/legislation & jurisprudence/psychology/therapy, Cooperative Behavior, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Interdisciplinary Communication, Interview, Psychological, Male, *Mandat
This clinical report updates a 2005 report from the American Academy of …
This clinical report updates a 2005 report from the American Academy of Pediatrics on the evaluation of sexual abuse in children. The medical assessment of suspected child sexual abuse should include obtaining a history, performing a physical examination, and obtaining appropriate laboratory tests. The role of the physician includes determining the need to report suspected sexual abuse; assessing the physical, emotional, and behavioral consequences of sexual abuse; providing information to parents about how to support their child; and coordinating with other professionals to provide comprehensive treatment and follow-up of children exposed to child sexual abuse.
Kaplan DM, Moore JL, Hirway P, Barron CE, Goldberg AP. A Comprehensive Pediatric Acute Sexual Assault Protocol: From Emergency Department to Outpatient Follow-up.. Pediatric Emergency Care. 2021; 37 (2) : 62-69.
Keywords: Child, *Child Abuse, Sexual/diagnosis/therapy, Emergency Service, Hospital, Follow-Up Studies, Humans, *Outpatients, Retrospective Studies, *Sex Offenses
OBJECTIVE: Close medical follow-up after pediatric acute sexual assault is …
OBJECTIVE: Close medical follow-up after pediatric acute sexual assault is recommended and may mitigate adverse consequences and decrease long-term comorbidities. The objectives are to (1) examine adherence to a comprehensive outpatient medical follow-up protocol after evaluation in the emergency department in a pediatric population and (2) identify characteristics associated with patient adherence to inform the utilization of a medical follow-up protocol after pediatric acute sexual assault. METHODS: A retrospective medical record review was conducted of patients younger than 18 years presenting to the emergency department from January 1, 2010, to December 31, 2013, with a discharge diagnosis suggestive of sexual assault/abuse. We examined differences in demographics, assault characteristics, and medical/legal needs of patients who were evaluated in follow-up versus patients who were not. RESULTS: Of 182 patients, 60.4% completed follow-up appointments with the child protection center. Younger patients had follow-up rates higher than older patients (70.2% vs 50%; odds ratio [OR], 0.42). For patients where child protective services or law enforcement were called, follow-up rates were 74.2% and 64.7%, respectively (OR, 2.5; OR, 3.1). All patients with anogenital injuries on initial examination were seen in follow-up. The majority of patients who followed-up were accompanied by a caregiver/relative (95%). CONCLUSIONS: (1) Caregivers should be integrated into the evaluation to facilitate compliance with follow-up; (2) child abuse specialists may be consulted to facilitate specific interventions and recommendations; (3) professionals should work as a multidisciplinary team; and (4) the patient's psychological status should be evaluated, and mental health interventions recommended.
Kellogg ND, Farst KJ, Adams JA. Interpretation of medical findings in suspected child sexual abuse: An update for 2023.. Child Abuse & Neglect. 2023; 145 : 106283.
Keywords: Humans, Child, *Child Abuse, Sexual/diagnosis, Sexual Behavior, Consensus, Health Personnel
Health care professionals who examine children who may have been sexually …
Health care professionals who examine children who may have been sexually abused need to be able to recognize, and photo-document any physical signs, and to have access to expert reviewers, particularly when signs concerning for sexual abuse are found. Although the general consensus among practitioners is that children will show few signs of sexual abuse on examination, there is considerable variability and rates of positive exam findings among practitioners of different professions, practice settings, and countries. This review will summarize new data and recommendations regarding the interpretation of medical findings and sexually transmitted infections (STIs); assessment and management of pediatric patients presenting with suspected sexual abuse or assault; and testing and treating patients for STIs. Updates to a table listing an approach to the interpretation of medical findings are presented, and reasons for changes are discussed.
Keogh A, Goldberg A, Schroeder C, Slingsby B, Hardy E, Michelow IC. Anogenital HSV in Children: Should Providers Be Concerned for Sexual Abuse?. Journal of Pediatric and Adolescent Gynecology. 2023; 36 (3) : 263-267.
Keywords: Female, Pregnancy, Child, Humans, Infant, Newborn, Infant, Child, Preschool, *Sex Offenses, *Sexually Transmitted Diseases/diagnosis/epidemiology, *Child Abuse, Colposcopy, Physical Examination, *Child Abuse, Sexual/diagnosis
OBJECTIVE: Anogenital herpes simplex virus (HSV) is most commonly acquired via …
OBJECTIVE: Anogenital herpes simplex virus (HSV) is most commonly acquired via sexual transmission, although other nonsexual modes of transmission have been proposed. When a child presents with a first-time outbreak of anogenital HSV, providers must consider sexual abuse. There are currently no evidence-based consensus guidelines to inform management of these patients. The purpose of this study was to describe how child abuse pediatricians (CAPs) evaluate children with anogenital HSV infection and determine whether any consistent practice patterns are followed. PARTICIPANTS AND SETTING: The patients included in this study were children between the ages of 0 and 12 years with a first-time outbreak of anogenital HSV who were medically evaluated by a CAP. METHODS: Patient charts were retroactively reviewed for the period of January 1 2004 to May 1 2020. RESULTS: Twenty-two cases were referred for evaluation by a CAP in the chosen time frame. Fifteen were seen in person. Ten of these patients were interviewed, 15 had an anogenital exam with colposcopy, and 14 were tested for at least one other sexually transmitted infection. A diagnosis of sexual abuse was made for 1 patient. CONCLUSION: This study demonstrates that although nonsexual transmission of anogenital HSV may be possible, providers must still consider sexual abuse. Children with a first-time outbreak of anogenital HSV should have a comprehensive evaluation for sexual abuse, including interview, physical exam, and testing for sexually transmitted infections. Evidence-based concerns for sexual abuse should be reported to child protective services.
Killough E, Spector L, Moffatt M, Wiebe J, Nielsen-Parker M, Anderst J. Diagnostic agreement when comparing still and video imaging for the medical evaluation of child sexual abuse.. Child Abuse & Neglect. 2016; 52 : 102-9.
Keywords: Analysis of Variance, Child, Child Abuse, Sexual/*diagnosis, Clinical Competence/standards, Female, Forensic Psychiatry, Humans, Observer Variation, Pediatricians/standards, Photography, Physical Examination, Prospective Studies, Video Recording
Still photo imaging is often used in medical evaluations of child sexual abuse ( …
Still photo imaging is often used in medical evaluations of child sexual abuse (CSA) but video imaging may be superior. We aimed to compare still images to videos with respect to diagnostic agreement regarding hymenal deep notches and transections in post-pubertal females. Additionally, we evaluated the role of experience and expertise on agreement. We hypothesized that videos would result in improved diagnostic agreement of multiple evaluators as compared to still photos. This was a prospective quasi-experimental study using imaging modality as the quasi-independent variable. The dependent variable was diagnostic agreement of participants regarding presence/absence of findings indicating penetrative trauma on non-acute post-pubertal genital exams. Participants were medical personnel who regularly perform CSA exams. Diagnostic agreement was evaluated utilizing a retrospective selection of videos and still photos obtained directly from the videos. Videos and still photos were embedded into an on-line survey as sixteen cases. One-hundred sixteen participants completed the study. Participant diagnosis was more likely to agree with study center diagnosis when using video (p<0.01). Use of video resulted in statistically significant changes in diagnosis in four of eight cases. In two cases, the diagnosis of the majority of participants changed from no hymenal transection to transection present. No difference in agreement was found based on experience or expertise. Use of video vs. still images resulted in increased agreement with original examiner and changes in diagnostic impressions in review of CSA exams. Further study is warranted, as video imaging may have significant impacts on diagnosis.
Mackenzie B, Jenny C. The use of alternate light sources in the clinical evaluation of child abuse and sexual assault.. Pediatric Emergency Care. 2014; 30 (3) : 207-10.
Keywords: Child, Child Abuse, Sexual/*diagnosis, Fluorescence, Humans, *Light, Physical Examination/*methods, Rape/*diagnosis
Alternate light sources are devices that produce visible and invisible light at …
Alternate light sources are devices that produce visible and invisible light at specific wavelengths to allow for enhanced visualization of fluorescent substances. These devices (which include Wood's lamp and blue light) are often used in forensics for evidence collection and can be quite useful to physicians in the medical evaluation of suspected physical or sexual assault. An understanding of the proper applications, as well as the limitations, of each alternate light source is imperative to correctly performing and interpreting medical evaluations in the emergency department. This review discusses the evidence from prospective trials in children and adults on the ability of specific alternate light sources to identify evidence of physical or sexual assault and also highlights some promising new technological adjuncts to alternate light sources that may allow for accurate dating of bruising.
O'Hara MA, Swerdin HR, Botash AS. Expanding Trauma-Informed Care to Telemedicine: Brief Report From Child Abuse Medical Professionals.. Clinical Pediatrics. 2023; 62 (1) : 5-7.
Keywords: Child, Humans, *Child Abuse/diagnosis, *Telemedicine
Schaul M, Schwark T. Rare (uro-)genital pathologies in young girls mimicking sexual abuse.. International Journal of Legal Medicine. 2022; 136 (2) : 623-627.
Keywords: Child, *Child Abuse, Sexual/diagnosis, Child, Preschool, Female, Hemorrhage/etiology, Humans, Perineum/injuries, *Sex Offenses, *Urethral Diseases/complications/diagnosis, Vagina
Examinations of young children for suspicions of sexual abuse are challenging …
Examinations of young children for suspicions of sexual abuse are challenging for the involved medical specialists because the consequences of the interpretation of the findings can be severe and dramatic. A broad knowledge of differential diagnoses including rare pathologies like urethral prolapse and failure of the midline fusion of the perineum, known as perineal groove, is essential in order to avoid unnecessary diagnostics and treatment, prejudgment, and to reduce patient family's anxiety. We report two independent cases of girls aged 7 months and 5 years suffering from these rare pathologies, one presenting with painless lower genital tract bleeding, the other showing a lesion of the perineum as random finding during a neuropediatrician's consultation. In both cases, the pathologies were initially misdiagnosed as injuries due to sexual assault, and judicial investigation procedures were initiated. In this paper, the characteristic symptoms and morphology of urethral prolapse and perineal groove are presented to enhance the awareness of these pathologies among forensic experts and help to establish the correct diagnosis.
Spriggs M. Children and bioethics: clarifying consent and assent in medical and research settings.. British Medical Bulletin. 2023; 145 (1) : 110-119.
Keywords: Child, Humans, *Decision Making, *Informed Consent
INTRODUCTION: The concept of consent in the pediatric setting is complex and …
INTRODUCTION: The concept of consent in the pediatric setting is complex and confusing. Clinicians and researchers want to know whose consent they should obtain, when a child can provide independent consent and how that is determined. The aim of this article is to establish what produces the justification to proceed with medical or research interventions involving children and the role of consent in that. I clarify concepts such as consent, assent, capacity and competence. SOURCE OF DATA: Literature review. AREAS OF AGREEMENT: Engaging with children and involving them in decisions about matters that affect them is a good thing. AREAS OF CONTROVERSY: The role of competence or capacity and the question of when a child can provide sole consent. GROWING POINTS: Flawed assumptions around competence/capacity. AREAS FOR DEVELOPING RESEARCH: An account of children's well-being that accommodates children's interests during the transition to adulthood.
Stavas N, Shea J, Keddem S, Wood J, Orji W, Cullen C, Scribano P. Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination.. Child Abuse & Neglect. 2018; 85 : 47-57.
Keywords: Adolescent, Adult, Caregivers/*psychology, Child, Child Abuse, Sexual/*diagnosis, Child Advocacy, Female, *Health Knowledge, Attitudes, Practice, Humans, Interviews as Topic, Male, Middle Aged, Qualitative Research, *Telemedicine
BACKGROUND: Childhood sexual abuse is a common cause of morbidity and mortality. …
BACKGROUND: Childhood sexual abuse is a common cause of morbidity and mortality. All victims should receive a timely comprehensive medical exam. Currently there is a critical shortage of child abuse pediatricians who can complete the comprehensive child sexual abuse examination. Telemedicine has emerged as an innovative way to provide subspecialty care to this population. Despite the growing popularity of telemedicine, no literature exists describing patient and caregiver perceptions of telemedicine for this sensitive exam. OBJECTIVE: To explore caregiver and adolescent perspectives of the use of telemedicine for the child sexual abuse examination and discover factors that drive satisfaction with the technology. PARTICIPANTS AND SETTING: Caregivers and adolescents who presented for a child sexual abuse medical evaluation at our county's child advocacy center. METHODS: We completed semi structured interviews of 17 caregivers and 10 adolescents. Guided by the Technology Acceptance Model interviews assessed perceptions about: general feelings with the exam, prior use of technology, feelings about telemedicine, and role of the medical team. Interviews were audio-recorded, transcribed, coded and analyzed using content analysis with constant comparative coding. Recruitment ended when thematic saturation was reached. RESULTS: There was an overwhelming positive response to telemedicine. Participants reported having a good experience with telemedicine regardless of severity of sexual abuse or prior experience with technology. Behaviors that helped patients and caregivers feel comfortable included a clear explanation from the medical team and professionalism demonstrated by those using the telemedicine system. CONCLUSION: Telemedicine was widely accepted by adolescents and caregivers when used for the child sexual abuse examination.
Trübner K, Schubries M, Beintker M, Bajanowski T. Genital findings in boys suspected for sexual abuse.. International Journal of Legal Medicine. 2013; 127 (5) : 967-70.
Keywords: Balanitis/diagnosis, Child, Child Abuse/*diagnosis, Child Abuse, Sexual/*diagnosis, Child, Preschool, Constriction, Pathologic/etiology, Diagnosis, Differential, Edema/etiology/pathology, Hematoma/etiology/pathology, Humans, Hypospadias/diagnosis, Infant,
Injuries in the genital region of boys are mostly caused by accidents. In this …
Injuries in the genital region of boys are mostly caused by accidents. In this study, three cases of child abuse and one case suspicious for child abuse but explainable by a congenital undiscovered malformation are presented. Injuries or findings in the genital region are especially suspicious for child abuse, including sexual abuse. Because of the possible misinterpretation and the consequences of a false confirmation of a child abuse, an interdisciplinary cooperation between pediatrics, forensic experts, and pediatric urologist should be carried out in doubtful cases.
